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Establishing an injury indicator for severe paediatric injury
Ian Pike1,2, Mina Khalil3, Natalie L Yanchar4
1Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Insights
A new severe pediatric injury indicator, using International Classification of Diseases-10 codes, reliably identifies severe pediatric trauma cases. This tool aids in tracking trends and identifying at-risk populations for improved care.
Area of Science:
- Traumatology
- Pediatric Injury Surveillance
- Health Informatics
Background:
- Hospitalization data for injuries can be unreliable due to external factors like policy changes.
- A robust indicator for severe pediatric injury is needed to overcome data variability.
- Existing methods lack a consistent definition for severe pediatric trauma.
Purpose of the Study:
- To identify International Classification of Diseases-10 (ICD-10) codes indicative of severe pediatric injuries.
- To develop and validate a specific indicator for severe pediatric trauma.
- To create a more stable metric for assessing pediatric injury trends.
Main Methods:
- Utilized two datasets with Injury Severity Score (ISS) and survival risk ratio to generate a diagnostic list.
- Engaged trauma surgeons to classify diagnoses for severity and need for trauma center care.
- Specified and validated the indicator using a separate real-world dataset.
Main Results:
- Identified 60 diagnoses representing severe pediatric injury.
- Applied the indicator to a comprehensive pediatric injury dataset.
- Observed a steeper decline in hospitalizations for severe injuries compared to non-severe, suggesting data stability.
Conclusions:
- The developed indicator provides a reliable method for evaluating severe pediatric trauma trends.
- This tool can assist in identifying pediatric populations at higher risk for severe injuries.
- Findings can inform policies for referring severe childhood injuries to appropriate care levels.
Background:
Routinely gathered injury data, such as hospitalisations, may be subject to variation from sources other than injury incidence. There is a need for an indicator that defines severe injury, which may be less vulnerable to fluctuations due to changes in care policies. The purpose of this study was to identify International Classification of Diseases-10 codes associated with severe paediatric injuries and to specify and validate a severe paediatric injury indicator.
Methods:
Two data sets that included the ISS and the survival risk ratio were used to produce a list of diagnoses to define severe paediatric injury. The list was sent to trauma surgeons who classified each code as severe enough or not severe enough to require care in a trauma centre. The indicator was fully specified, then validated by using a different data set to validate the codes in a real-world situation.
Results:
Sixty diagnoses were identified as representing severe paediatric injury. Following specification, the indicator was applied to an existing comprehensive data set of paediatric injuries. The decline in hospitalisation of paediatric injuries was significantly steeper for severe than non-severe injuries, suggesting that factors related to the decline in this trauma subset are unlikely to be related to changes in access or other components of trauma care delivery.
Conclusions:
This indicator can be used for the evaluation of trends in severe paediatric trauma and will help identify populations at risk. This research may inform policies and procedures for referrals of severe childhood injury to appropriate levels of care.
